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Chapter 5
Themes
and Colors
Key
LitCharts assigns a color and icon to each theme in The Power of Habit, which you can use to track the themes throughout the work.
Habits, Human Behavior, and Success
Habit Change and Personal Growth
Social Habits and Cultural Influence
The Moral Consequences of Habits
Summary
Analysis
An 86-year-old man went to the Rhode Island Hospital emergency room after a fall caused blood to start pooling in his head. While the hospital was one of the best in the world, it also suffered severe internal divisions. The nurses went on strike to protest dangerous working conditions and abusive treatment from doctors. The nurses got used to making extra efforts to fix doctors’ errors and accommodate their rage. The hospital’s culture was the opposite of Alcoa’s: it was toxic and developed erratically, without any real planning.
Whereas Starbucks’s effective organizational habits contributed to its success, Rhode Island Hospital’s dysfunctional habits caused a series of catastrophic failures. Specifically, the hospital didn’t efficiently balance power and authority among its employees. This underlines Duhigg’s central point about habits: they can make or break the people and organizations that exercise them.
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The Rhode Island Hospital’s culture caused serious problems. The 86-year-old fall victim’s paperwork didn’t say which side of his head needed the operation. When a nurse proposed pulling up the brain scans to check, the neurosurgeon surgeon yelled at her, modified the man’s medical consent forms, and then drilled into the wrong side of his head. The man died two weeks after the surgery, and the family successfully sued the hospital. The surgeon was fired. But the nurses knew that an error like this was inevitable because of the hospital’s culture. While thoughtless leaders often promote dysfunctional institutional habits, effective leaders can build better ones—even during a crisis.
The surgeon who botched the operation is clearly responsible for this man’s death, but Duhigg argues that the hospital’s overall culture is also responsible. This is because the hospital’s culture encouraged the surgeon’s misbehavior instead of stopping it. Again, this shows that dysfunctional habits have serious consequences. It also suggests that organizations have a moral responsibility to develop effective habits, even if doing so can be incredibly difficult and require major change.
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In their influential 1982 book An Evolutionary Theory of Economic Change, Yale professors Richard Nelson and Sidney Winter argued that organizations’ behavior is really controlled by institutional routines, not rational choices. These routines help organizations perform consistently over time. They also enable rival factions to work together by building truces, even as they compete for power. For instance, executives can often get ahead by sabotaging their rivals, but most companies discourage this. So, rival executives make a truce to work together for the company’s benefit.
Success at work usually depends on informal habits like who to trust, who has power, and how to get things done. For instance, highly creative fashion designers can’t succeed unless they develop the right logistical routines. To do this, they usually have to work at other fashion companies and build truces with others in the process. In contrast, the truce between doctors and nurses at Rhode Island Hospital didn’t hold together. The nurses bent over backwards to accommodate the doctors, who didn’t care about them—and often didn’t even learn their names. To fix this dynamic, the hospital’s leaders needed to build better organizational habits.
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"My students can't get enough of your charts and their results have gone through the roof." -Graham S.
In 1987, a London Underground worker learned about a burning tissue at the bottom of a long escalator at the King’s Cross subway station. He ran down and put it out, but he didn’t ask what happened or tell anyone about the incident. Although more passengers reported smoke, the station staff delayed calling the fire brigade. Meanwhile, passengers kept arriving at the station.
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More than a half hour after the burning tissue, a fireman finally got to the station. The whole escalator was already on fire. To avoid tardiness, trains refused to let disembarking passengers back in, even though they could tell that the station was on fire. Then, the whole escalator exploded. Because the fire brigade couldn’t coordinate with the Underground management, the fire took six hours to put out. More than 30 people died.
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The Underground’s informal rules were responsible for this catastrophe. For instance, employees learned not to overstep their bounds, didn’t know how to use the sprinklers or fire extinguishers, and were encouraged not to call the fire brigade—who weren’t supposed to use other agencies’ hydrants. All of these informal rules made sense in isolation. But they also meant that, at the end of the day, nobody was responsible for passenger safety. This shows that truces can actually be dangerous. Paradoxically, organizations need to balance authority evenly and give some people ultimate authority over others. To do this, they have to do what Tony Dungy and Howard Schultz did: take advantage of a crisis.
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As the Rhode Island Hospital repeatedly botched surgeries, it gained national media attention. Doctors started fighting with reporters. Then the hospital’s chief quality officer declared that the media attention was an opportunity for the hospital to completely rework its culture. The hospital gave the entire staff a day-long training, redesigned surgical safety procedures, and created an anonymous reporting system for safety issues.
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Other hospitals, like Boston’s Beth Israel, have taken similar steps after major public mistakes. So have organizations like NASA and the international airline industry, which both overhauled safety standards after major accidents. After the 1987 London Underground fire, a special investigator started learning what happened. Everyone knew that the Underground needed to improve its fire safety, but nobody had taken responsibility for it, so the investigator took his inquiry public and published an extremely critical report about the Underground’s dysfunctional bureaucracy. The Underground immediately reformed itself by appointing safety managers and empowering employees to report problems.
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